Modern concepts in the treatment of urogenital Chlamydia trachomatis infection during pregnancy
Tyutyunnik V.L., Mikhailova O.I., Kan N.E., Mirzabekova D.D.
Chlamydia infection is one of the most common sexually transmitted infections which is caused by the intracellular microorganism Chlamydia trachomatis. Chlamydia has a tropism to the cylindrical epithelium and is capable of affecting the mucous membrane of the urethra, cervical canal, rectum, oropharynx and conjunctiva of the eyes. In women, chlamydial infection can cause cervicitis, urethritis, pelvic inflammatory diseases, tubal factor infertility. During pregnancy, this infection is a provocative factor for preterm birth, premature rupture of membranes, intrauterine infection of the fetus and low birth weight. The analysis of the studies presented in this review substantiates the need for timely detection and treatment of chlamydia infection, especially during pregnancy. In this regard, the choice of an effective and safe drug during gestation is an important issue. The review examines the principles of diagnosis and treatment regimens for urogenital chlamydia infection in pregnant women. Data from clinical studies on the effectiveness and safety of azithromycin in the treatment of cervicitis of chlamydial etiology in this category of patients are presented.
The article presents a description of clinical cases on the use of Azithromycin EXPRESS in pregnant women with diagnosed C. trachomatis infection.
Conclusion: Treatment with Azithromycin EXPRESS was accompanied by clinical and microbiological recovery, with no adverse reactions during therapy or complications in the ante- and postnatal period.
Authors’ contributions: Tyutyunnik V.L., Mikhailova O.I., Kan N.E., Mirzabekova D.D. – development of research design, obtaining data for analysis, review of publications on the topic of the article, processing and analysis of the material, writing the text, editing the article.
Conflicts of interest: The authors declare no possible conflicts of interest.
Funding: The study was conducted without sponsorship.
Ethical Approval: The study was approved by the Ethical Review Board of the Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
Patients’ Consent for Publication: The patients provided an informed consent for the publication of their data.
For citation: Tyutyunnik V.L., Mikhailova O.I., Kan N.E., Mirzabekova D.D. Modern concepts in the treatment of urogenital Chlamydia trachomatis infection during pregnancy.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (4): 148-154 (in Russian)
https://dx.doi.org/10.18565/aig.2024.64
Keywords
chlamydia infection
Chlamydia trachomatis
Azithromycin EXPRESS
pregnancy
References
- Министерство здравоохранения Российской Федерации. Хламидийная инфекция. Клинические рекомендации (протокол лечения). М.: Российское общество дерматовенерологов и косметологов, Российское общество акушеров-гинекологов; 2021. 35 с. [ Ministry of Health of the Russian Federation. Chlamydial infection. Clinical recommendations (treat;ent protocol). Moscow: Russian Society of Dermatovenerologists and Cosmetologists, Russian Society of Obstetricians and Gynecologists; 2021. 35 p. (in Russian)].
- Савельева Г.М., Сухих Г.Т., Серов В.Н., Радзинский В.Е., ред. Акушерство. Национальное руководство. 3-е изд., М.: ГЭОТАР-Медиа; 2022. 1080 с. [Savelyeva G.M., Sukhikh G.T., Serov V.N., Radzinsky V.E., eds. Obstetrics. National Guide. 3rd ed. Moscow: GEOTAR-Media; 1080 p. (in Russian)].
- Adachi K.N., Nielsen-Saines K., Klausner J.D. Chlamydia trachomatis screening and treatment in pregnancy to reduce adverse pregnancy and neonatal outcomes: a review. Front. Public Health. 2021; 9: 531073. https://dx.doi.org/10.3389/fpubh.2021.531073.
- Ghasemian E., Harding-Esch E., Mabey D., Holland M.J. When bacteria and viruses collide: a tale of Chlamydia trachomatis and sexually transmitted viruses. Viruses. 2023; 15(9): 1954. https://dx.doi.org/10.3390/v15091954.
- Witkin S.S., Minis E., Athanasiou A., Leizer J., Linhares I.M. Chlamydia trachomatis: the persistent pathogen. Clin. Vaccine Immunol. 2017; 24(10): e00203-17. https://dx.doi.org/10.1128/CVI.00203-17.
- Murray S.M., McKay P.F. Chlamydia trachomatis: Cell biology, immunology and vaccination. Vaccine. 2021; 39(22): 2965-75. https://dx.doi.org/10.1016/j.vaccine.2021.03.043.
- Illingworth M., Hooppaw A.J., Ruan L., Fisher D.J., Chen L. Biochemical and genetic analysis of the Chlamydia GroEL chaperonins. J. Bacteriol. 2017; 199(12): e00844-16. https://dx.doi.org/10.1128/JB.00844-1g.
- Elwell C., Mirrashidi K., Engel J. Chlamydia cell biology and pathogenesis. Nat. Rev. Microbiol. 2016; 14(6): 385-400. 10.1038/nrmicro.2016.30.
- Prusty B.K., Chowdhury S.R., Gulve N., Rudel T. Peptidase inhibitor 15 (PI15) regulates chlamydial CPAF activity. Front. Cell. Infect. Microbiol. 2018; 8: 183. https://dx.doi.org/10.3389/fcimb.2018.00183.
- Schott B.H., Antonia A.L., Wang L., Pittman K.J., Sixt B.S., Barnes A.B., Valdivia R.H., Ko D.C. Modeling of variables in cellular infection reveals CXCL10 levels are regulated by human genetic variation and the Chlamydia-encoded CPAF protease. Sci. Rep. 2020; 10(1): 18269. https://dx.doi.org/10.1038/s41598-020-75129-y.
- Кравченко Е.Н., Охлопков В.А., Набока М.В. Антибактериальная терапия хламидийной инфекции во время беременности. Доктор.Ру. 2016; 3: 39-42. [Kravchenko E.N., Okhlopkov V.A., Naboka M.V. Antibacterial therapy for Chlamydial infection during pregnancy. Doctor.Ru. 2016; (3): 39-42. (in Russian)].
- Passos L.G., Terraciano P., Wolf N., Oliveira F.D., Almeida I., Passos E.P. The correlation between Chlamydia trachomatis and female infertility: a systematic review. Rev. Bras. Ginecol. Obstet. 2022; 44(6): 614-20. https://dx.doi.org/10.1055/s-0042-1748023.
- Menon S., Stansfield S.H., Logan B., Hocking J.S., Timms P., Rombauts L. Development and evaluation of a multi-antigen peptide ELISA for the diagnosis of Chlamydia trachomatis-related infertility in women. J. Med. Microbiol. 2016; 65 (9): 915-22. https://dx.doi.org/10.1099/jmm.0.000311.
- den Heijer C.D.J., Hoebe C.J.P.A., Driessen J.H.M., Wolffs P., van den Broek I.V.F., Hoenderboom B.M. et al. Chlamydia trachomatis and the risk of pelvic inflammatory disease, ectopic pregnancy, and female infertility: a retrospective cohort study among primary care patients. Clin. Infect. Dis. 2019; 69 (9): 1517-25. https://dx.doi.org/10.1093/cid/ciz429.
- He W., Jin Y., Zhu H., Zheng Y., Qian J. Effect of Chlamydia trachomatis on adverse pregnancy outcomes: a meta-analysis. Arch. Gynecol. Obstet. 2020; 302 (3): 553-67. https://dx.doi.org/10.1007/s00404-020-05664-6.
- Hoenderboom B.M., van Bergen J.E.A.M., Dukers-Muijrers N.H.T.M., Götz H.M., Hoebe C.J.P.A., de Vries H.J.C. et al. Pregnancies and time to pregnancy in women with and vithout a previous Chlamydia trachomatis infection. Sex. Transm. Dis. 2020; 47(11): 739-47. https://dx.doi.org/10.1097/OLQ.0000000000001247.
- Reekie J., Roberts C., Preen D., Hocking J.S., Donovan B., Ward J., Mak D.B., Liu B. Chlamydia and Reproductive Health Outcome Investgators. Chlamydia trachomatis and the risk of spontaneous preterm birth, babies who are born small for gestational age, and stillbirth: a population-based cohort study. Lancet Infect. Dis. 2018; 18(4): 452-60. https://dx.doi.org/10.1016/S1473-3099(18)30045-8.
- Хашукоева А.З., Хлынова С.А., Керчелаева С.Б., Маркова Э.А., Димитрова В.И., Бурденко М.В. Урогенитальный хламидиоз: алгоритм ведения и лечения. Акушерство и гинекология. 2023; 9 (Приложение): 19-24. [Khashukoeva A.Z., Khlynova S.A., Kerchelaeva S.B., Markova E.A., Dimitrova V.I., Burdenko M.V. Urogenital chlamydia: management and treatment algorithm. Obstetrics and Gynecology. 2023; 9 (Supplement): 19-24. (in Russian)].
- Дубровина С.О. Роль хламидий в этиологии воспалительных заболеваний органов малого таза. Акушерство и гинекология. 2017; 2: 119-24. [Dubrovina S.O. The role of chlamydia in the etiology of pelvic inflammatory diseases. Obstetrics and Gynecology. 2017; (2): 119-24. (in Russian)].
- Министерство здравоохранения Российской Федерации. Нормальная беременность. Клинические рекомендации (протокол лечения). М.; 2023. 90 с. [Ministry of Health of the Russian Federation. Normal pregnancy. Clinical guidelines (treatment protocol). Moscow; 2023. 90 p. (in Russian)].
- Веселов А.В., Козлов Р.С. Азитромицин: современные аспекты клинического применения. Клиническая микробиология и антимикробная химиотерапия. 2006; 8(1): 18-32. [Veselov A.V., Kozlov R.S. Azithromycin: current clinical use. Clinical Microbiology and Antimicrobial Chemotherapy. 2006; 8(1): 18-32. (in Russian)].
- Physicians Desk Reference. 57th ed. Montvale, NJ: Thomson PDR; 2004, 2684.
- Pitsouni E., Iavazzo C., Athanasiou S., Falagas M.E. Single-dose azithromycin versus erythromycin or amoxicillin for Chlamydia trachomatis infection during pregnancy: a meta-analysis of randomised controlled trials. Int. J. Antimicrob. Agents. 2007; 30(3): 213-21. https://dx.doi.org/10.1016/j.ijantimicag.2007.04.015.
- Инструкция по медицинскому применению препарата «Азитромицин ЭКСПРЕСС». [Instructions for medical use of Azithromycin EXPRESS. (in Russian)].
- Суханов Д.С., Марьюшкина В.С., Азовцев Д.Ю., Оковитый С.В. Место азитромицина в комплексной терапии COVID-19. Преимущества и эффективность применения диспергируемой формы в амбулаторных условиях. Лечащий врач. 2021; (9): 59-64. [Sukhanov D.S., Maryushkina V.S., Azovtsev D.Yu., Okovity S.V. Azithromycin in the complex therapy of COVID-19. Advantages and effectiveness of the use of the dispersed form in outpatient settings. Lechaschi Vrach. 2021; (9): 59-64. (in Russian)]. https://dx.doi.org/10.51793/OS.2021.24.9.011.
- Зырянов С.К., Байбулатова Е.А. Использование новых лекарственных форм антибиотиков как путь повышения эффективности и безопасности антибактериальной терапии. Антибиотики и химиотерапия. 2019;64(3-4): 81-91. [Zyryanov S.K., Baibulatova E.A. The use of new dosage forms of antibiotics as a way to improve the effectiveness and safety of antibiotic therapy. Antibiotics and Chemotherapy. 2019; 64(3-4): 81-91. (in Russian)].
- Перечень взаимозаменяемых препаратов, 2022. Информация Министерства здравоохранения РФ от 7 ноября 2022 г. Об обновленном (дополненном) перечне взаимозаменяемых лекарственных препаратов. [List of interchangeable products, 2022. Information of the Ministry of Health of the Russian Federation dated November 7, 2022 On the updated (supplemented) list of interchangeable drugs. (in Russian)].
- Асхаков М.С., Чеботарев В.В., Чеботарева Н.В. Современный подход акушеров-гинекологов к терапии хламидийной инфекции у беременных и его обоснованность. Современные проблемы науки и образования. 2018; 3: 62. [Askhakov M.S., Chebotarev V.V., Chebotareva N.V. The modern approach of obstetrician-gynecologists to the treatment of chlamydial infection in pregnant women and its validity. Modern problems of Science and Education. 2018; 3: 62. (in Russian)]. https://dx.doi.org/10.17513/spno.27686.
- Чеботарев В.В., Асхаков М.С., Чеботарева Н.В., Щетинин Е.В. Макролиды в лечении урогенитальной инфекции: доказанная эффективность или маркетинговая политика фармацевтических компаний? Медицина. 2018; 1: 25-41. [Chebotarev V.V., Askhakov M.S., Chebotareva N.V., Shchetinin E.V. Macrolides in the treatment of urogenital infections: proven efficacy or marketing policy of pharmaceutical companies? Medicine. 2018; 1: 25-41. (in Russian)]. https://dx.doi.org/10.29234/2308-9113-2018-6-1-25-41.
Received 20.03.2024.
Accepted 01.04.2024
About the Authors
Victor L. Tyutyunnik, Professor, Dr. Med. Sci., Leading Researcher of the Center for Scientific and Clinical Research, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparina str., 4, +7(903)969-50-41, tioutiounnik@mail.ru, Researcher ID: B-2364-2015, SPIN-code: 1963-1359, Authors ID: 213217, Scopus Author ID: 56190621500, https://orcid.org/0000-0002-5830-5099Olga I. Mikhailova, PhD, Researcher, 1 Maternity Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparina str., 4, +7(926)564-68-13, omikhaylova@gmail.com, https://orcid.org/0000-0001-7569-8704
Natalia E. Kan, Professor, Dr. Med. Sci., Deputy Director of Science, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparina str., 4, +7(926)220-86-55, kan-med@mail.ru, Researcher ID: B-2370-2015,
SPIN-code: 5378-8437, Authors ID: 624900, Scopus Author ID: 57008835600, https://orcid.org/0000-0001-5087-5946
Dzhamilia D. Mirzabekova, graduate student, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparina str., 4, +7(906)110-51-13, +7(920)984-94-07, Jamilya1705@yandex.ru, https://orcid.org/0000-0002-2391-3334
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